| NPI | 1457068892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 35309) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSB94027197) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY35309) | |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2025-08-26 |